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N D & a e L | e 5 Form 1045 L Rev. Nov. 1941 P AMERICAN RED CROSS 40 - a 0 NURSING SERVICE a Name in full Davenport , havenia Irene Tel. No. Wo 5857 + (last) (first) (middle) If married, give maiden name Best, hi venia Year of birth 1894 M Marital status married Husband's name Dayenpont , Poyal W. 1 (single, married, widowed, divorced) S Permanent address 64 28 31st St nw. H. 6 (street) (city) (county) (state) Probable address F bore L for the next year (street) (city) (county) (state) a Give name and address of nearest relative or friend in United States: < Haren port, R.W. Husband n.w. (b (name) (relationship) (address) 5 Are you employed in nursing at the present time? Yes No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed a Institutional Public health H Industrial C Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service - MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) Psychiatric Nursing Operating room Anaesthesia Public health 'nursing 2. Have you taken any courses in a college or university? Less than One Two Three Four Bachelor's Master's P.H.D. Certificate in *one year year years years years degree degree degree Public Health X In what major field was above study? Health Education What languages, other than English, do you speak? 215142 * Academic year (OVER)

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    "ocrText": "N\nD\n&\na\ne\nL\n|\ne\n5\nForm 1045\nL\nRev. Nov. 1941\nP\nAMERICAN RED CROSS\n40 -\na\n0\nNURSING SERVICE\na\nName in full Davenport , havenia Irene\nTel. No. Wo 5857\n+\n(last)\n(first)\n(middle)\nIf married, give maiden name\nBest, hi venia\nYear of birth 1894\nM\nMarital status\nmarried\nHusband's\nname Dayenpont , Poyal W.\n1\n(single, married, widowed, divorced)\nS\nPermanent address 64 28 31st St nw.\nH. 6\n(street)\n(city)\n(county)\n(state)\nProbable address\nF bore\nL\nfor the next year\n(street)\n(city)\n(county)\n(state)\na\nGive name and address of nearest relative or friend in United States:\n<\nHaren port, R.W. Husband\nn.w.\n(b\n(name)\n(relationship)\n(address)\n5\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\na\nInstitutional\nPublic health\nH\nIndustrial\nC\nPrivate duty\nOther (write in)\nGovernment Service:\nArmy, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\n-\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health 'nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nX\nIn what major field was above study? Health Education\nWhat languages, other than English, do you speak?\n215142\n* Academic year\n(OVER)"
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